tbuckley/cabot-search huggingface dataset:
Abstract 13392: 3D TEE Aids in Assessment of Embolic Stroke Due to Aortic Atherosclerotic Plaque
Authors: Songnan Wen, Tasneem Z Naqvi
Journal: Circulation (2022)

Case Presentation: A 69-year-old right-handed man presented with new left-sided weakness and recurrent ischemic strokes. His had history of coronary artery disease, diabetes mellitus, hypertension, dyslipidemia, chronic kidney disease stage 3, obstructive sleep apnea and obesity. Plasma low-density lipoprotein was 127 mg/dL. Brain MRI showed diffusion restriction in the left caudate head, left corona radiata, left anterior lentiform nucleus, and left periventricular white matter from acute to subacute infarction. CT angiogram showed diffuse atheromatous disease in the anterior and posterior circulation, bilateral mild cervical internal carotid artery stenosis, and calcifications in the aortic arch ( Figure 1 ). Transthoracic echocardiogram (TTE) showed mild generalized left ventricular hypokinesis (ejection fraction 45%) without thrombus. Transesophageal echocardiogram (TEE) showed complex mobile atherosclerotic plaques in the aortic arch ( Figure 2 ) after which Apixaban &amp; Clopidogrel were started and statins increased. At 1-year follow-up there was no recurrent stroke. Discussion: This case highlights the role of 3D TEE in the detection of complex aortic arch atherosclerotic plaque with mobile components as the etiology of recurrent embolic stroke. 2D TTE &amp; TEE and CT chest were unable to show mobile components in the aortic arch plaque. Many patients identified as having “cryptogenic stroke” after 2D TTE &amp; TEE may in fact have mobile aortic arch plaques which can only be delineated by 3D TEE, thus reducing the need for further workup and expediting appropriate treatment.
Abstract 14461: Post Transcatheter Aortic Valve Replacement (TAVR) Mortality Outcomes in Patients With and Without Severe LV Dysfunction (LVEF&lt;35%): A Pooled Analysis
Authors: Sanskriti Shrivastava, Krutarth K Pandya, Najam Saqib, NISHANT SETHI
Journal: Circulation (2022)

Background: Transcatheter aortic valve replacement (TAVR) is indicated in patients with severely reduced left ventricular ejection fraction (LVEF) and can restore left ventricular (LV) function. However, mortality outcomes in this unique subset of patients has been studied only in limited cohorts. Methods: Extensive search on PubMed and Google Scholar yielded 1069 reports meeting inclusion criteria. These studies were independently evaluated by 2 physicians. Nine studies comparing all-cause mortality in patients undergoing TAVR with and without severely reduced LVEF (&lt;35%) were included with a total of 31,952 patients. A study-level analysis was done using Review manager 5.3. As a guide, an I2 &gt;30% was considered an indicator of statistical heterogeneity among the studies. A Mantel-Haenszel Random effects model was used to calculate the Odds Ratio for homogeneous endpoints. A p value &lt;0.05 was considered significant. Results: 30-day and 1-year all-cause mortality was significantly higher among patients with severely reduced LVEF yielding Odds Ratios of 1.80[CI 1.33-2.87; p=0.01; I 2 = 77%] (A) and 1.81 [1.65-1.99 p&lt;0.001; I 2 = 26%] (B). respectively. Conclusion: There is a staggering 80% increased risk of short- and long-term mortality in patients with severely reduced LV function following TAVR. These findings are concerning despite lack of randomized data. Interdisciplinary management with advanced heart failure teams should be undertaken pre-emptively in these patients for close monitoring and early intervention.
Abstract 13451: Cardiovascular Complications During Delivery Admissions Associated With Assisted Reproductive Technology: A National Inpatient Sample Analysis (2008-2019)
Authors: Salman Zahid, Anas Hashem, Anum A Minhas, Colleen Harrington, Odayme Quesada, Niti R Aggarwal, Chrisandra Shufelt, Valerie Baker, Erin D Michos
Journal: Circulation (2022)

Introduction: Persons who conceived through Assisted Reproductive Technology (ART) have an increased risk of obstetric-associated complications. Hypothesis: ART is associated with increased acute cardiovascular (CV) complications during delivery admissions. Methods: We used data from the National Inpatient Sample (2008-2019) while utilizing ICD-9 or ICD-10 codes to identify delivery hospitalizations and ART procedure. Results: A total of 45,867,086 weighted delivery cases were identified, of which 0.24% were among individuals who conceived through ART (n=108,542). Persons with an ART history were older at the time of delivery (median 35 vs. 28 years, p&lt;0.01) and had higher prevalence of hypertension, gestational diabetes, and dyslipidemia (all, p&lt;0.01). After adjustment for age, race/ethnicity, comorbidities, multiple gestation, insurance, and income, ART remained an independent predictor of peripartum CV complications including preeclampsia (aOR 1.48 [1.45-1.51], p&lt;0.01), heart failure (aOR 1.94 [1.10-3.40], p&lt;0.01), and cardiac arrhythmias (aOR 1.39 [1.30-1.48], p&lt;0.01) compared to natural conception. Likewise, the risk of acute kidney injury (aOR 2.57 [2.25-2.92], p&lt;0.01), stroke (aOR 1.57 [1.23-2.01], p&lt;0.01), pulmonary edema (aOR 2.29 [2.02-2.61], p&lt;0.01), and venous thromboembolism (aOR 1.92 [1.63-2.25], p&lt;0.01) were higher with ART. However, higher odds of developing peripartum cardiomyopathy or acute coronary syndrome were not associated with ART. Length of stay (3 vs. 2 days, p&lt;0.01) and cost of hospitalization ($5,903 vs. $3,922, p&lt;0.01) were higher for deliveries among persons with history of ART. Conclusions: Persons who conceived with ART had higher risk of preeclampsia, heart failure, cardiac arrhythmias, pulmonary edema, AKI, stroke, and VTE during their delivery hospitalizations. This may in part contribute to increased resource utilization seen in patients conceiving with ART
Abstract 13780: Sociodemographic Differences in Patient Portal Research Recruitment of Older Adults With Heart Failure
Authors: Lyndsay Degroot, Hailey Miller, Noelle Pavlovic, Anna Peeler, Nisha A Gilotra, Patricia Davidson, Nancy Perrin, Sarah Szanton, Sydney Dy, Martha Abshire
Journal: Circulation (2022)

Introduction: Innovative recruitment strategies such as patient portal messaging (PPM) hold promise for high yield, low-cost recruitment of heart failure (HF) patients for research studies but may impact the diversity of the sample. We aimed to examine strategies used to recruit older adults with advanced HF during COVID-19 in an ongoing prospective palliative care research study. Methods: We used three recruitment strategies including the traditional in-person HF clinic screening or provider referral, and a more innovative direct-to-patient recruitment approach using EHR patient portal messaging (PPM) or email. We compared characteristics of participants recruited via PPM/email and traditional in-person recruitment strategies using chi-squared and t-tests. We used multiple logistic regression to examine associations between participant characteristics and recruitment type. Results: Most participants were recruited through PPM or email (86%, n=247) over 10 months and the remaining participants were recruited through provider referral or in-person recruitment at the heart failure clinic over 6 months (14%, n=40). Among our sample of 287 participants, 67% (n=201) were White, 28% (n=84) were Black, and the remaining 5% (n=13) were Asian, American Indian, or Alaska Native or identify with a non-listed race. The mean age was 68 years old. There was no significant difference in recruitment type by age, gender, or financial strain. There was a significant difference in recruitment type by race and education level. In a multiple logistic regression adjusting for age, gender, and financial strain, Black participants had a lower odds of PPM recruitment than white participants (OR 0.15, p&lt;0.001). Additionally, those with higher education showed higher odds of PPM/email recruitment (OR 4.2 p = 0.001). Conclusions: In this study, PPM was an efficient recruitment strategy with higher odds of recruiting participants of White race and higher education compared to traditional recruitment strategies. Use of both traditional and more innovative direct-to-patient recruitment strategies may promote a more diverse study sample.
Abstract 13606: Deletion of CD47 <i>Specifically</i> in Lymphatic Endothelium Augments Arterial Lymphangiogenesis and Attenuates Atherosclerosis
Authors: Bhupesh Singla, Ravi Varma Aithabathula, Wonmo Ahn, Gabor Csanyi
Journal: Circulation (2022)

Thrombospondin-1 (TSP1), an extracellular glycoprotein mediates differential physio- or pathological effects via interacting with cell surface receptors including CD36 and CD47. TSP1 is a well-known angiogenesis inhibitor, however, its role in regulating lymphangiogenesis is not clear. We recently reported that global CD47-deficient mice are protected from atherosclerosis, however, myeloid cell-specific CD47 loss augments lesion formation suggesting the importance of cell-specific CD47 blockade in atherosclerosis. Our experiments revealed CD47 as a dominant TSP1 receptor in lymphatic endothelial cells (LECs). As the lymphatic vasculature is functionally linked to atherosclerosis, we herein investigated the effects of LEC TSP1-CD47 signaling inhibition on lymphangiogenesis and atherosclerotic lesion formation. Our immunoblotting data demonstrated elevated TSP1 expression in human and mouse atherosclerotic aortic tissue compared to non-atherosclerotic control tissue. TSP1 at pathological concentrations inhibited VEGF-C-stimulated in vitro lymphangiogenesis. Mechanistically, TSP1 inhibited VEGF-C-induced Akt activation in LECs, leading to decreased eNOS phosphorylation and attenuated nitric oxide production. Further, TSP1-treated CD47-silenced LECs proliferate faster and have higher Akt and eNOS activation than TSP1-treated control cells. AAV8-PCSK9-injected LEC-specific CD47 knockout ( Cd47 f/f Lyve-1 Cre +/- ) mice had reduced atherosclerosis in both aorta and aortic root compared with control ( Cd47 f/f ) mice. Additional immunostaining experiments performed on aortic root cross-sections indicated improved lymphatic vessel density in Cd47 f/f Lyve-1 Cre +/- mice. These results demonstrate that TSP1-mediated LEC CD47 activation inhibits lymphangiogenesis and blockade of LEC CD47 signaling suppresses atherosclerosis. Altogether, these findings identify LEC CD47 as a potential therapeutic target in atherosclerosis.
Abstract 14584: Successful Cardiac Targeting of a Superoxide Dismutase-Loaded Nanoparticle in a Rodent Ischemia-Reperfusion Model
Authors: David A Herbst, Sara Guevara-Plunkett, Bonirath Chhay, Jessica Dominic, Amit Iyengar, Noah Weingarten, Danika Meldrum, Mark R Helmers, Andrew Tsourkas, zhiliang cheng, Pavan Atluri
Journal: Circulation (2022)

Introduction: Encapsulating superoxide dismutase (SOD) in a semi-porous nanoparticle (NP) preserves myocardial function in rats following ischemia-reperfusion (I/R) injury. Cardiac targeting maximizes enzyme efficacy by enhancing retention. This study describes the formulation, characterization, and functional analysis of cardiac myosin (CM) targeted SOD NP. Method Targeted SOD NP with anti-CM antibody was developed in three steps and characterized with dynamic light scattering (DLS), colorimetric SOD assay, and in vitro imaging with isolated mature rat cardiomyocytes. In vivo function was assessed with a rat model of cardiac I/R injury in which the LAD was occluded for 60 minutes, ligation was released, and treatments were injected in the myocardium. Animals were recovered for 28 days and terminal pressure-volume (PV) loop analysis was performed. Result Anti-CM SOD NP was formulated by first encapsulating SOD in a polymersome containing an azide functional group. Second, a photoreactive antibody-binding domain was bonded to the azide. Third, covalent bonding of the NP to anti-CM antibody was performed with UV-light activation (Fig 1A). Consistent size was confirmed by DLS during formulation (Fig 1B). In vitro visualization of rhodamine-tagged anti-CM NP bound to mature cardiomyocytes confirmed antibody conjugation (Fig 1C). SOD activity was preserved during formulation and after degradation with Triton X, confirming conjugation did not affect porosity (Fig 1D). 53 rats underwent I/R injury and were randomized to 4 treatment groups of which 44 survived to terminal analysis (Fig 1E). Rats injected with anti-CM SOD NP had preserved EF (med 57%) and significant improvement in EF compared to PBS (med 40%, p=0.04). Conclusion Cardiac targeting of SOD NP with anti-CM antibody was successful and preserved EF in a rat I/R model. Ongoing future steps include correlation of scar volume with PV loop data, myocardial retention analysis and biodistribution of anti-CM NP.
Abstract 14528: Impact of Environmental Factors on Cardiovascular Death Comparing Two First World Countries: Great Britain and United States of America: Global Burden of Disease 2019 Study
Authors: Anoop Titus, Pramukh Arun Kumar, Mahati Dasari, Anu Saji, Abiram Baburaj, Nirav Patel, Sohaib Minhas, Bandar AlYami, Nida Mohamed, M. Sakil Syeed, FNU Avinashsingh Eswarsingh
Journal: Circulation (2022)

Introduction: Environmental exposure has an important role in the development and progression of cardiovascular death (CVD). We studied the 30-year CVD in countries with similar risk factors comparing the environmental exposures. Methods: Populations with environmental risk factors (Table 1), who died between 1990 and 2019 in the GBR and USA were selected from GBD 2019 Study. The 30-year mean CVD death was compared using Welch's t-test. Trends of the CVD deaths with pertaining risk factors over total CVD were estimated. Results: A total of 33,041,416 patients were analyzed. Mortality rates among lead and particulate matter pollution exposed populations were found to be significantly different. In lead exposure, the USA has observed more deaths (RR=0.024 vs. 0.014, p=&lt;0.001) compared to the GBR, whereas the death was more in particulate matter exposure in the GBR (RR=0.065 vs. 0.050, p=0.001). No statistically significant difference was found in case of smoking and second-hand smoke exposure. In mortality trend analyses in terms of percentage of CVD death, a steady declining pattern was seen in both countries in all four risk factors (Fig 2). Conclusions: CVD proportions was significantly higher in USA in population with higher risk of lead exposure, while particulate matter showed higher proportion of CVD in GBR- for which further research is warranted.*GBD=Global Burden of Disease
Abstract 14572: Exposure to Multiple Size Fractions of Particulate Matter Air Pollution and Sudden Cardiac Death
Authors: William Borchert, Jaime E Hart, Rachel Nethery, Christine M Albert, Francine Laden
Journal: Circulation (2022)

Introduction: Recent literature has suggested an association between short-term exposures to air pollution and sudden cardiac death (SCD). There is little known on the relationship between medium- and long-term exposure to particulate matter air pollution (PM) and SCD. Moreover, most studies focus on PM less than 2.5μm in diameter (PM 2.5 ) and have not considered larger coarse particles (PM 2.5-10 ) or the effect of combined exposures. Methods: 117,358 women in the Nurses’ Health Study, a nationwide prospective cohort, returned biannual questionnaires to update health status and risk factors. Suspected and definite SCD cases from 1988 to 2013 were identified by medical records and next of kin reports. Spatiotemporal models estimated the monthly exposures to PM at each residence. We calculated time-varying 12 month moving averages as a measure of long-term exposure and the difference between 12- and 3-month moving average and the difference between 3-month and 1-month moving averages as measures of medium-term exposure for both PM 2.5 and PM 2.5-10 . Time-varying Cox proportional hazard models were used to examine the association between all size fractions and time windows and SCD, and to calculate hazard ratios with corresponding 95% confidence intervals. The basic model was adjusted for age, year, season, and region, and a full model also considered demographics, medication use, health history, and socioeconomic status. Results: During 2,070,408 person-years of follow-up, there were total 351 definite and probable SCDs. Medium term exposures to both PM 2.5 and PM 2.5-10 were associated with risk of SCD, although the specific time windows of greatest risk varied ( Table 1 ). Notably, in our full model, exposure to PM 2.5-10 was associated with SCD (Hazard Ratio: 1.07; 95% Confidence Interval: 1.02, 1.13). Conclusions: PM air pollution in the past month or season may be an important contributor to the population level risk of SCD.
Abstract 13426: Efficacy and Safety of Hypothermia as Adjuvant Therapy for Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis
Authors: Ali Mir, Mohammed Rahman, Khaled Ragab, Sarah Elsayed, Ahmed H Fathallah, Abdulrahman Hagrass, Ibrahim Kamal, Ronak Bahuva, Waseem Farooq, Hassan Khan
Journal: Circulation (2022)

Objective: Randomized control trials (RCT) conducted on myocardial infarction (MI) patients regarding the efficacy of therapeutic hypothermia (TH) as an adjunct to percutaneous coronary intervention (PCI) have shown inconsistent results. This study aims to compare the use of TH in patients with MI undergoing PCI with control groups. Methods: We systematically searched four databases; PubMed, Scopus, Web of Science, and Cochrane for studies conducted until March 2022. The inclusion criteria were any study design that compared TH in patients with MI undergoing PCI with a control group. Infarct size percentage and recurrent MI were primary efficacy outcomes. Mortality, major adverse cardiovascular events (MACE), and overall bleeding complications were primary safety outcomes. The risk of bias assessment of the included RCTs was conducted through Cochrane tool, while the quality of the included cohort studies was assessed by the NIH tool. The meta-analysis was performed on RevMan. Results: A total of 19 studies were included; 15 RCTs, one case-control, and three cohort studies. Infarct size percentage was significantly reduced in TH group as compared to control (MD= -1.76, 95% CI [-3.04, -0.47), p=0.007), but the TH group had a higher incidence of bleeding complications (OR= 1.88, 95% CI [1.11, 3.18), p=0.02). There were no significant differences between TH and control groups in mortality (OR= 1.06, 95% CI [0.75, 1.50), p=0.73) or recurrent MI (OR= 1.21, 95% CI [0.64, 2.30), p=0.56). Conclusion: In patients with MI, TH reduces infarct size while increasing bleeding complications. Mortality and recurrent MI outcomes are not significantly reduced.
Abstract 14504: Gender and Racial Disparities in Patients Using Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors and Glucagon-Like Peptide-1 (GLP-1) Analogues in a Real-World Scenario
Authors: Aakash Tuli, Jobin Varghese, Damien Smith, Hector Garcia-Garcia
Journal: Circulation (2022)

Introduction: Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors and Glucagon-like Peptide-1 (GLP-1) analogues are relatively new classes of prescription drugs showing promising benefits for cardiovascular outcomes. There is a paucity of data regarding the cardiovascular risk profile of patients receiving these medications outside of clinical trials. We aim to describe the same in the Medstar Health outpatient population and to explore whether there are any racial/gender disparities. Methods: Records were obtained for 12,305 patients who had been reviewed as outpatients in the Medstar Health System and prescribed either an SGLT2-I or a GLP1-A between 2018 and 2021 inclusive. 2379 patients had sufficient data to allow calculation of their athero-sclerotic cardiovascular disease (ASCVD) risk. Variables collected included demographic information, selective vitals, and lab values. Patients’ ASCVD risk was calculated where appropriate using 2013 ACC/AHA guidelines. Results: Of 2379 patients, 1695 (71.2%) were prescribed a GLP1-A and 684 (28.8%) an SGLT2-i. Groups did not differ in terms of smoking status, use of anti-hypertensive medications, history of ACS or stroke, systolic blood pressure, or cholesterol levels. The GLP1-A group had more female patients (60.4% vs. 45.8% in the SGLT2-i group, p &lt; 0.001), more African American patients (52.0% vs. 40.0%, p &lt; 0.001), and fewer patients with diabetes mellitus (26.3% vs. 27.9%, p &lt; 0.001). The GLP1-A group was also significantly younger, had a higher average BMI, and higher average HDL and lower average HbA1c (7.68 vs 8.06, p &lt; 0.001). 10-year ASCVD risk was significantly higher in patients prescribed an SGLT-2 inhibitor (18.10 vs 15.66, p &lt; 0.001). Conclusions: Among demographic indicators, there were proportionally more women and African-Americans in the GLP1-A group than in the SGLT2-i group, which may indicate disparity in utilization of these drugs for certain populations. There were more diabetics in the SGLT2-i group, likely reflecting the use of GLP1-As for obesity in non-diabetics. The 10-year ASCVD risk was lower in the GLP1-A group compared to the SGLT2-i group. Further research will explore the clinical outcomes of these groups.
Abstract 13296: The Internal Jugular Vein for Leadless Pacemaker Implantation in Patients Under 30 Kg
Authors: Souleiman Salameh, Daniel Cortez
Journal: Circulation (2022)

Pacemaker placement in pediatrics involves consideration for potential complications with leads, pocket erosion and infection. Pacemaker generators also carry their own complications such as hematoma formation and additional infection. This is why a reliable leadless pacemaker implantation technique is desired. In this dual center, single operator, retrospective study we demonstrate the feasibility of leadless pacemaker implantation via internal jugular vein in patients under 30 kg. This technique does not require surgical cut-down and preserves the patency of the involved vessels. Procedures were conducted by an electrophysiologist at the University of Minnesota and UC Davis Medical Center and University of Minnesota Medical Center from 2018-2021 with the Micra (Medtronic, Minneapolis, MN, USA). Vascular access in the largest diameter internal jugular vein was obtained in the right or left internal jugular veins via the Seldinger technique with serial dilation from 5 or 8 French size to 27 French. Results showed that in eight patients under 30kg, leadless pacemaker can implanted via the internal jugular vein with no need for surgical cut down due to having good short-term and mid-term vein patency. Seven out of eight patients were discharged the next day after the procedure. No venous complications related to access were noted. All patients met an indication for pacemaker implantation with ventricular-only pacing needed or had prophylactic leadless pacemaker placed or was the patient and cardiology team preference after multi-disciplinary discussion. We recommend echocardiographic guidance to minimize perforation risk.